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Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study
  1. Lucy Hives1,
  2. Alice Bradley2,
  3. Jim Richards3,
  4. Chris Sutton4,
  5. James Selfe5,
  6. Bhaskar Basu6,
  7. Kerry Maguire7,
  8. Gail Sumner8,
  9. Tarek Gaber9,
  10. Annice Mukherjee10,
  11. Raymond N Perrin3
  1. 1School of Dentistry, University of Central Lancashire, Preston, UK
  2. 2Department of Neurophysiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  3. 3Allied Health Research Unit, University of Central, Lancashire, UK
  4. 4Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
  5. 5Department of Health Professions, Manchester Metropolitan University, Manchester, Greater Manchester, UK
  6. 6University Hospital of South Manchester NHS Foundation Trust/ Central, Manchester University Hospitals NHS Foundation Trust, Rehabilitation Medicine, Manchester, UK
  7. 7Department of Osteopathy, The Good Health Centre, County Clare, Ireland
  8. 8Back to Health Physiotherapy, Bolton, UK
  9. 9Taylor Rehabilitation Unit leigh, Leigh Infirmary, Leigh, Greater Manchester, UK
  10. 10Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Professor Jim Richards; JRichards{at}


Objective To assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment.

Methods This was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin’s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min.

Results Ninety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18–60. Cohen’s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, p<0.001) and moderate for postural/mechanical disturbance of the thoracic spine (κ=0.57, p<0.001) and Perrin’s point (κ=0.56, p<0.001). A McNemar’s test found no statistically significant bias in the diagnosis by the experienced AHP relative to actual diagnosis (p=1.0) and a marginally non-significant bias by the newly trained AHP (p=0.052). There was, however, a significant bias in the diagnosis made by the physician relative to actual diagnosis (p<0.001), indicating poor diagnostic utility of the clinical neurological and rheumatological assessment.

Conclusions Using the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.

  • chronic fatigue syndrome
  • screening
  • assessment
  • physical signs

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  • Contributors LJH recruited participants, collected data and analysed the data. ARB recruited participants and collected data. JR initiated the project, designed the research methods and analysed the data. CS wrote the statistical analysis plan and analysed the data. JS initiated the project and designed the research methods. BB, KM and GS collected data. TG and AM recruited participants. RNP initiated the project and designed the research methods. All authors drafted and revised the paper.

  • Funding This work was supported by The Fund for Osteopathic Research into Myalgic Encephalomyelitis (registered charity number: 1045005).

  • Competing interests This research explored the findings by one of the co-authors, RNP. To avoid any conflict of interest, he was not involved in any of the recruitment of participants, clinical examinations, data collection or analysis. RNP’s role in the study was to assist with developing the design, writing the protocol, setting up the project coordinating committee with the different clinical recruitment centres, applying for ethical approval and assisting with the writing of the introduction and methods of the paper. There were no other conflicts of interest.

  • Ethics approval NRES Committee North West-Lancaster (REC reference 12/NW/0877).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The relevant anonymised patient level data are available on request from the corresponding author.